Evaluation of Corticosteroid and Methotrexate Therapy in the Treatment of Moderate to Severe Localized Scleroderma (Morphoea) – A 5 Year Study in a Teaching Hospital of North India

Introduction: Localized scleroderma is a rare disorderwith not well recognized aetiology. Though consideredto be a benign disorder it may result in a severe cosmeticdisfigurement or even functional disability. There is no proveneffective therapy for localized scleroderma so far makingmanagement of such cases challenging. Lack of evidencebased treatment and standardization of evaluation methodsmay be reason for it. The Study was conducted to evaluatethe role of corticosteroid and methotrexate therapy in ourpopulation with severe localized scleroderma (morphoea).Material and Methods: All patients attending with OPD inDepartment of Dermatology SKIMS-MCH from Jan, 2014,to Jan, 2019, with clinical features suggestive of active,moderate to severe morphoea were enrolled in the study. Adetailed clinical history was followed by a thorough clinicalexamination and calculation of LoSSI score. Patients werestarted on i/v methyl-prednisolone 30mg/kg monthly pulsesas 3 consecutive doses for 3 months (maximum 1gm) andintramuscular MTX at 0.2 to 0.4 mg/kg/week (maximum 25mg/week) for 12 months.Results: A total of 21 patients were included in the study.Male: Female ratio was 1:3.2. Mean age was 21.19years.Linear morphoea was most common type (13 cases) followedby plaque morphoea (6 cases). There was a significantdecrease in mean LoSSI score (from 15.19 to 6.62) at 4months after completion of steroid methotrexate phase (valueof t is -8.621425, value of p is < .00001). Mean LoSSI scoreafter completion of 12 months of treatment was 0.94 (valueof t is -9.644953, value of p is < .00001). The treatment waswell tolerated.Conclusion: The study suggests that systemic corticosteroidsand methotrexate in combination is effective and well toleratedtreatment for both adults and children with localized moderateto severe scleroderma.